What causes cauda equina syndrome?
Cauda equina syndrome is a condition in which nerves at the base of the spinal cord become compressed. The nerves are connected to the legs, feet and pelvic organs, including those responsible for bowel and bladder control and sexual function.
If cauda equina is allowed to progress it can lead to paralysis, or at least impairment of walking function, loss of bladder and/or bowel control, and partial or complete loss of sexual function.
“Partial” or “incomplete” cauda equina syndrome involves the patient retaining some bladder control. The condition is “established” or “complete” when the patient has no ability to urinate at all, and is in urinary retention.
If the patient does not receive treatment before the condition is “complete” the outcome will be significantly worse, and this is the reason why cauda equina is a medical emergency.
What might cause cauda equina syndrome?
Cauda equina syndrome is most commonly caused by a lumbar herniated disc. Essentially, disc material escapes (either due to chronic degeneration or as a result of an acute incident) and begins to place pressure on the nerves within the cauda equina.
However, there are a number of other ways in which cauda equina syndrome can arise:
- As a complication arising from surgery to the lumbar spine
- Following direct trauma to the cauda equina region, such as in a car accident or fall
- As a result of a tumour placing pressure on the spinal canal
- From an infection of the spinal canal (osteomyelitis)
- From an inflammatory condition such as ankylosing spondylitis
- As a result of spinal stenosis (narrowing of the spinal canal), placing pressure on the nerves within the cauda equina.
Might cauda equina syndrome be related to another spinal injury or illness?
There are a number of ways in which cauda equina syndrome may be caused by other spinal conditions.
Sometimes surgery to treat another condition in the lumbar spine may result in surgical complications and damages the nerves in the cauda equina. However, other conditions which might cause cauda equina syndrome, such as:
- A tumour – A spinal tumour may cause pressure on the spinal canal, injuring the nerves in the cauda equina. Such a tumour could be a primary (or, where the tumour began), but is more likely to be a secondary tumour which has metastasized (or spread) from another part of the body
- Spinal Osteomyelitis – Spinal osteomyelitis is an infection of a vertebrae in the spine. It is a rare condition, but can lead to damage to the cauda equina if an abscess forms and places pressure on the spinal canal.
- Inflammatory conditions, such as ankylosing spondylitis.
How do I know my cauda equina syndrome has been caused by medical negligence?
Cauda equina syndrome is sometimes caused or worsened by negligent medical care. This typically occurs if there is delay in either referring somebody with suspected cauda equine symptoms to hospital, or in making the diagnosis and treating it appropriately when admitted to hospital.
There may often be only a short window of opportunity between the condition being “incomplete” (where prompt intervention may produce a reasonably favourable outcome) and “complete”, after which it is unlikely that any intervention will alter the outcome. Time is therefore “of the essence” in treatment of the condition.
If you believe that there may have been any delay in your treatment – either at the primary care stage or after admission to hospital – it would be worth instructing a specialist solicitor to investigate your claim.
Furthermore, if you have undergone surgery to the lumbar spine for another spinal condition, but have ended up with symptoms consistent with cauda equina syndrome (pain, numbness, paralysis, loss of bowel and/or bladder function, loss of sexual function) again you should seek legal advice. It may be that this outcome was avoidable if the surgery had been conducted competently.
Finally, if cauda equina syndrome has occurred following spinal surgery, and you were not warned prior to undergoing the procedure that this was a risk of the procedure, you may have a claim on the basis that you did not give properly informed consent. To succeed in such a claim, you would need to prove that, if you had received the appropriate warning, you would not have gone ahead with the operation, at least at that particular time and by that particular surgeon. It is then open to you to argue that you would not have sustained the injury.